AHI & Morbidity

[OklahomaFP]

I tried doing a pubmed search and couldn't come up with what I was looking for, so I thought I would ask the experts here on the forum.

My question is in a hypothetical patient if his AHI were say 50-60 and then he used CPAP or had MMA surgery (some intervention) and his AHI were reduced to 30 and no longer had daytime sleepiness, what impact does this have on his overall morbidity. i.e:

Does a reduction in AHI have a linear relationship to adverse events and are there studies that show this? (is an AHI of 30 better than 50, or is it really the same because its still severe).

Thanks in advance.

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[OklahomaFP]

eh, found my answer after a little more digging.

[FONT=verdana, arial, helvetica, sans-serif][FONT=verdana, arial, helvetica, sans-serif]Shahar E, Whitney CW, Redline S; et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163(1):19-25. [FONT=verdana, arial, helvetica, sans-serif]FREE FULL TEXT...

 

[painmd87]

I tried doing a pubmed search and couldn't come up with what I was looking for, so I thought I would ask the experts here on the forum.

My question is in a hypothetical patient if his AHI were say 50-60 and then he used CPAP or had MMA surgery (some intervention) and his AHI were reduced to 30 and no longer had daytime sleepiness, what impact does this have on his overall morbidity. i.e:

Does a reduction in AHI have a linear relationship to adverse events and are there studies that show this? (is an AHI of 30 better than 50, or is it really the same because its still severe).

Thanks in advance.

I'd be interested in hearing an attending's view on this. I'm particularly interested in the relationship between stroke+RDI, while OP is looking at cvd. There appears to be a strong link between OSA+stroke.

While I view taking an AHI 50 -> 30 as an "improvement," it's not much of one. You're still looking at a significant amount of apnea. The question for this particular pt is why was PAP not effective in reducing AHI to < 5/hr? Normalizing respiration would theoretically give the best outlook re: morbidity, but I'm not sure what kind of results you'd get in going from 50->30.

http://www.uihealthcare.com/topics/medicaldepartments/neurology/apneaandstroke/index.html

Next, our group compared the prevalence of OSA in acute stroke patients with normal gender- and age-matched control subjects. OSA was diagnosed in 71% of the stroke patients and in only 19% of the controls. We found that a higher-than-expected percentage of patients (54%) experienced their strokes during sleep (p=0.0304). In a follow-up study, we found that, of the five patients in this group who had OSA and died, four suffered their original stroke during sleep.

(if you're wondering why a pre-med ventured into the realm of the sleep forum, I'm an RPSGT who will be an MS1 come July)